Urinary Elimination (Exam 2) Flashcards
Micturition
-Complex process involving bladder, urinary spinchters, and CNS
-Impulses from the brain respond or ignore the urge
Voiding
Bladder contraction and urethral sphincter and pelvic floor muscles
Factors Influencing Urinary Elimination
-Growth and Development
-Sociocultural factors
-Psychological factors
-Personal habits
-Fluid intake
-Pathological condition
-Surgical procedures
-Diagnostic examinations
Changes in Older Adults: Increased
-Bladder irritability
-Bladder contraction during bladder filling
-Risk of urinary incontinence
Changes in older adults: Decreased
-Amount of nephrons
-Bladder muscle tone
-Bladder capacity
-Time between initial desire to void and urgent need to void
Urinary Retention
-Inability to partially or completely empty the bladder
-Pressure, discomfort, pain
-Can be acute or chronic
How to diagnoses Urinary Retention
-Diagnose with Post-Void Residual (PVR)
-Bladder scanner or straight cath
Urinary Tract Infections
-Most common type is E-coli
Anywhere along urinary tract. Upper = kidneys. Lower=bladder
Bacteriuria
-Bacteria in the urine
-Does not mean UTI. Can be indicator though
UTI: Risk factors
-Presence of indwelling catheter
-Any instrumentation of urinary tract
-Urinary retention
-Fecal incontinence
-Poor hygiene
-Female
Forms of Urinary Incontinence
Urgency-Stress-Overflow-Functional
Often multifactorial
Urinary Incontinence: Overflow
-Poor bladder emptying or bladder obstruction
-Leaking and dribbling
-Urine stops and starts while peeing
-Males with BPH
Urinary incontinence: Stress
-Exertion: Laughing, coughing, sneezing, jumping, changing positions
-Usually women after childbirth
Urinary Incontinence: Urgenecy
-Overactive bladder
-Sudden and strong urge to urinate that is hard to delay
-Idopathic and older adults
Urinary Incontinence: Functional
Just not being able to get to the bathroom
Incontinecne Risk Factors
-More common in women and elderly
-Obesity
-Multiple pregnancies
-Neurological disorders
-Medications
-Confusion
-Dementia
-Immobility
-Depression
Assessing for CVA tenderness
-Costovertebral Angle
-Testing for Kidney infection
Normal Urine Output
> 30 mls/hr
Concerned about output
-If output is <30 mls/hr for 2 hours
-If patient is awake and has gone 6 hours without voiding
Urinary Chart
Screen shot
Urine Testing
-Know to collect the urine
-Label appropriately per hospital protocol
-Send as soon as you receive unless it is a timed test
-Know if you need a preservative or not
Urinalysis: Nursing Considerations
-Must be fresh
-Collect urine normal voiding, indwelling catheter, or urinary diversion
-Must have freshly voided urine
-Cannot take urine from catheter bag
Culture and Sensitivity
-Can obtain from clean void or clean catch mid stream urine specimen
-Send to lap within 30 min
-Preliminary report should be available within 24 hours
-Use STERILE cup
Abdominal Xray: KUB
-Determines size, shape, symmetry, location of structures of the urinary tract
-Common uses: (urinary calculi (kidney stone)
-No special Preparation
Maintaining Adequate Fluid Intake
-2300 mls/day if renal function is ok, no heart disease and no need for fluid restriction
-Helps flush solutes to limit bladder irritability
If fluid intake needs increased:
-Schedule time to drink
-Fluid Preferences
-High fluid foods (fruits)
-Stop drinking about 2 hours before bedtime to prevent nocturia
Incontinence Care
-Be respectful of patient feelings
-Pelvic floor muscle training
-Lifestyle changes
-Bladder retraining
-Toileting schedule
-Meticulous skin care
Meticulous Skin Care: Do’s
-Identify and treat
-use skin risk assessment tool
-Use appropriate skin barrier products
-Ensure adequate hydration
-Consult WOCN if needed
Meticulous Skin Care: Don’ts
-Use traditional soap and water
-Double padding the bed
-Leave soiled pads
Types of Urethral Cathetes
Single Lumen (No balloon)
Indwelling catheter (Temp sensing)
3 way / 3 lumen (Bladder irrigation)
Coude tip (Curved rounded) (enlarged prostate)
Other types of Catheters: Suprapubic
Placed in the bladder through abdominal wall. (Sutured in place) (Used when blockage of urethra or when indwelling catheter causes irritation)
Purewick
Sits in-between female patient legs and is hooked to genital suction
They are not dry
Condom Cath
Is what it is
Decrease risk of infection
Not fool proof
Nursing Care: Catheter Care
-Regular Perineal care (Peri-Care)
-Provide catheter care or baths per hospital protocol
-Secure catheter to prevent pulling or movement
-Empty drainage bags when it is 1/2 full
-Do not allow the bag to touch the floor
-Maintain a closed drainage system
-Timely removing
Before Catheter Insertion and While Indwelling
Peri-Care (Front to back) (Do not spread E-coli)
Males: Uncircumcised
-Can be delegated to nursing assistant or patients
-CHG wipes with bath and Castile wipes Q12 prn
Post-Catheter Removal
-At risk for urinary retention.
-If have not voided in 6 hours then assessing and bladder to scan to see if there is retention
-Greater than 400 preform in-out cathereization
Lower UTI
-Dysuria
-Frequent Urge
-Cloudy Urine
Upper UTI
-Back pain
-Fever
-Chills and shivering
-Confusion
-NVD
Incontinence is often multifactorial
